WentzMiller Global Services, LLC

Sign up to for this Newsletter!

Sign up to get interesting news and updates delivered to your inbox 6 times or more a year..

Email Address

First Name

Last Name

Organization

Email Lists

General Interest

Medical Education company

Medical society

Pharmaceutical company

By submitting this form, you are granting: WentzMiller Global Services LLC, 26913 N. 87th Lane, Peoria, Arizona, 85383, United States, http://www.wentzmiller.org permission to email you. You may unsubscribe via the link found at the bottom of every email. (See our Email Privacy Policy for details.) Emails are serviced by Constant Contact.

Global CME/CPD Newsletter

Keeping Up Around the World

November-December 2015

Dear CME/CPD Colleagues,

On behalf of my WMGS colleagues, I wish you all a Happy Thanksgiving, Glorious Hanukah, Merry Christmas and Happy New Year. May all you wish for come true in 2016 -- especially peace throughout the world.

-- Lew Miller Lew@wentzmiller.org

CME opportunities: diagnosis, multimorbidity

Reports from the US and UK highlight two neglected areas in continuing education for health professionals:

Reducing diagnostic errors. A sweeping reportfrom the US Institute of Medicine calls diagnostic errors "a blind spot" in healthcare delivery that has been around for years and harms "an unacceptable number of patients. The report notes:

At least 5% of US adults who seek outpatient care experience a diagnostic error, sometimes with "devastating consequences".

Diagnostic errors are a factor in 10% of patient deaths

Diagnostic errors account for up to 17% of hospital adverse events

Most Americans will experience at least one meaningful error in their lifetimes

Recommendations that CME providers can help carry out:

Make patients and their families part of the diagnostic process, including access to medical records and full disclosure of errors

Understand and improve integration of HIT tools into clinical workflows

Improve teamwork among diagnosticians, radiologists and pathologists

Understanding and treating multimorbidity. Two reports from the UK highlight this growing problem. A National Health Service report calls for fundamental change in the delivery of primary care, in particular treating an aging population with multiple disease states. An article by 2 University of Glasgow professors sees multimorbidity as a major challenge to health systems around the world, including in poor countries.Among the suggestions that CME providers can take into account:

Seek out guidelines based on multiple conditions, and encourage their development

Promote better integration of primary and secondary care services to improve communication among providers and reduce duplication of services. A Canadian study showed high satisfaction by patients with multiimorbdity and their families when care was integrated through case management.

An unpublished paper in process from WHO outlines the status of CME among family physicians in the Eastern Mediterranean Region, showing Iran among the leaders in integrating education and care, according to Prof. Michael Kidd, president of the World Organization of Family Doctors.

Iran, he notes, has a healthcare system that starts with community health workers in rural areas and makes universities of medical science responsible not only for education of health professionals but also for clinical services. The health ministry is now working to train a workforce of family physicians to reduce the burden of care on hospitals and specialists.

Iran and the UAE are the only two countries in the Eastern Mediterranean Region to have mandatory CME linked to licensing, hospital credentialing and recertification. Iranian doctors also rated their CME as excellent for relevancy, feedback and convenience.

Lifelong learning among Chinese rural physicians

How well do Chinese rural physicians keep up? What are the factors that influence their lifelong learning patterns? A reportfrom Liaoning Province provided these answers:

Physicians who participated in 15 days or more of CME per year had significantly higher lifelong learning scores than those who did not

Physicians in practice more than 30 years had higher scores than those with fewer working years; those with 21-30 years had the lowest scores

Career satisfaction and professional titles had a positive effect on physician attitudes toward lifelong learning

Providing rural physicians with more educational opportunities and abundant educational resources "may be an effective strategy", recognizing that many lacked technical skills to seek new information

A recent study evaluated NHS-London's approach to revalidation of responsible officers, those overseeing clinical governance in healthcare organizations. The role of independent skilled appraisers was highlighted. Revalidation has "the potential to improve healthcare standards" including quality.

CME researchers and readers can now benefit from a new collaboration between the editors of the Journal of Continuing Education in the Health Professions (JCEHP) and the Journal of European CME (JECME). JCEHP, long-established in North America, accepts only 15% of submitted manuscripts; those not accepted that fit within JECME's scope of topics will now be referred to JECME. Each journal will also publish announcements of new works published in the other.

Univadis, a Merck social network subsidiary with an active membership of more than 3 million healthcare providers in 90 countries, now will operate as part of Physicians Interactive, in which Merck has a controlling interest, but operates independently. Sermo, another social network for doctors, is now offering Spanish-language capability for its half a million subscribers in Spain and Mexico.

Do CME interventions re CVD make a difference?

Probably, say authors of a meta-analysis.Dissemination of guidelines alone had no effect. Interventions to improve adherence were sometime successful.

But the authors noted that there were so many guidelines, some in conflict, that results were uneven. And patients often had co-morbidities that were not accounted for.

A survey presented at the recent Cologne Consensus Conference showed some inconsistencies among CME professionals on who should be performing a function vs who is actually doing so.

Dr. Reinhard Griebenow noted that in many cases physician course directors or chairs supplanted the ideal of having an organizational team manage content and faculty selection, format selection and evaluation. How does your experience compare? Does it matter?

Managing MedEd processes globally: A new WMGS service for pharma and device companies

Are you considering how to manage grants or related activities for global or regional HCP educational programs? Several MedEd departments are moving in that direction already -- to provide uniform standards for providers, control quality and control costs. WMGS can assist you to:

Deal with internal roadblocks ... and external pitfalls

Extend your current grant and related processes to other countries/regions

Develop methods to manage grant activities and measure outcomes

Demonstrate budget benefits, including shared funding

... and more

WMGS has the knowledge and capability to help your department handle these challenges effectively. We would be pleased to set up a discussion by teleconference or at the Annual Conference of ACEHP January 13-16. For more information, contact any one of us:

Lew Miller, Principal, 212-933-1027 lew@wentzmiller.org

Greg Paulos, Principal, 623-748-3311 greg@wentzmiller.org

Barbara Pritchard, Principal, 917-881-9685 bpritch887@aol.com

Dennis Wentz MD, Principal, 406-586-9851 dkwentz95@gmail.com

Global CME/CPD Newsletter

Keeping Up Around the World

September-October 2015

Dear CME/CPD Colleagues,

Commercial support for CME activities is changing rapidly in the US and Europe. We discuss some major trends and how both commercial supporters and med ed providers can work together to bring about improved healthcare outcomes.

-- Lew Miller Lew@wentzmiller.org

Pharma and CME: Trends to watch

Are you aware of the sea changes occurring in commercial support of medical education, particularly in Europe and North America? Look for how your organization can adapt to and benefit from these major trends in the next 12-24 months:

Reduction or elimination of payments to physician attendees at major congresses. European associations of pharma and device companies have made this a goal. Med ed managers in companies and in providers have the opportunity to seek to shift those funds to support med ed activities directly -- both through grants to sponsoring medical specialty organizations to underwrite congress costs and through grants to support specific educational programs. (A related tough note was sounded by the British health secretary, warning senior medical staff that they "face the sack and threat of jail" for failing to disclose pharma gifts and hospitality.)

Shifts in funding sources from marketing departments to medical/scientific affairs. This has been a fait accompli in the US for years but is now a trend as well in Europe and perhaps other parts of the world. A new group of funding managers has an opportunity to learn more about what constitutes effective CME and how to judge grant requests. This trend may affect the relationship between "friends" in pharma marketing and med ed providers.

Shifts in commercial support from national grant-making to global/regional grant-making. A survey from the Industry Alliance of Continuing Education reported that many major companies are using US med ed grant-making processes, conforming to the regulations of the US Accreditation Council for CME (ACCME), to fund global, regional and even national CME programming. Shared decision-making between the global HQ and national/regional med ed managers may be the most appropriate path to follow. Med ed providers outside the US need to become familiar with ACCME requirements and tougher guidelines for submitting grant requests.

Emphasis on outcomes-based education. At the recent US Alliance Industry Summit, commercial supporters and med ed providers shared this as a common goal, awarding Best in Class Outcomes awards to several providers. Supporting this US trend, a McKinsey&Company report notes that payors and governments "have an ever sharper focus on managing costs while delivering improved patient outcomes."

Supporting education for the healthcare team -- including patients. Attendees at the Alliance Industry Summit learned that team performance and outcomes are directly correlated. A WEGO Health survey of patient influencers showed that respondents expected pharma's patient engagement to increase in effectiveness in the coming year.The McKinsey report identifies opportunities for pharma to create value through digital technology that the patient can use to monitor treatment, with feedback to physicians. More than half med ed departments now fund patient education as well.

Can CME providers help reduce 'profligate' waste in healthcare costs?

That is a challenge implicit in a critique of National Health Service waste by Sir Bruce Keogh, NHS medical director for England. In a recent interview, he said there was "no shame in admitting ... the problem of profligate waste and tackling it". Here are key comments from his office:

Ten-15% of medical and surgical treatments should not have been carried out

Sir Bruce told a conference of senior doctors and managers: "Historically, doctors .. and nurses have felt that the money is someone else's problem.... we need to collectively challenge that." He could have been speaking to doctors in dozens of countries which are facing similar problems in controlling costs while maintaining or improving quality. CME providers have an opportunity to address cost issues along with clinical care.

For example, in Serbia, one hospital used a CME intervention to affect clinicians' decisions to administer human serum albumin solutions for resuscitation of critically ill patients. The intervention resulted in a reduction of hospital days, the rate of sepsis patient mortality and costs.

GAME is going places...Canada...Scotland...India

The Global Alliance for Medical Education (GAME) just concluded a successful Annual Meeting held in Glasgow in conjunction with the Assn. for Medical Education in Europe (AMEE). The educationall session emphasized the need for rethinking CME/CPD planning to address healthcare professional team needs, including those of patients. Participants engaged in role-playing to help understand how to break down communications barriers as part of the development process.

Also, Dale Kummerle, chair of the iPACME SIG, reported that the group will shortly issue a document standardizing the definition of quality education across Europe, related to new directives of the European Federation of Pharmaceutical Industry Assns. (EFPIA).

Last May, at a Canadian regional meeting of GAME, attendees gained insights into the roles of major provider organizations in medicine and pharmacy, as well as industry's role in collaboration without control.

Next February 13, GAME will hold its second India regional conference in Mumbai, covering the trends towards new CME credit points, CME structure and industry's role. Contact vaibhav@insigniacom.com for more information.

Finally, GAME is scheduling a North American regional meeting in San Diego CA in mid-March in conjunction with the World Congress on Continuing Professional Development.

London-based healthcare communications agency GCI Health has appointed a diector of medical education as it gears up to deliver a new approach to integrated communications in Europe. New York-based health information specialist Medscape has opened a London office to serve as an international hub to serve Medscape and WebMD clients globally.

In the US, a 2009 law provided that physicians and hospital could receive Medicare and Medicaid incentive payments for demonstrating meaningful use of electronic health records. The tables have turned. More than 257,000 professionals are receiving a penalty this year for failing to meet meaningful use requirements -- reductions in payments of 1-2%.

A new study has identified 8 themes that helped doctors who had made harmful errors cope positively: talking about it, disclosure and apology, forgiveness, a moral contest, dealing with imperfection, learning/becoming an expert, preventing recurrences/improving teamwork, and helping others/teaching.

Mandatory CME for opioid prescribing?

That is what a leading physician has recommended to the Canadian Medical Assn. Dr. Douglas Grant of Nova Scotia says doctors are taking "a growing casual attitude about the risk of these medicines." At the same time, patients want to be pain free.

Education works to improve opioid prescribing, says a study of physician response to a live or online activity developed by Boston University School of Medicine. 87% of participants post-program said they would make at least one change to align practice with guidelines.

A team of US surgeons has established a successful, sustainable corneal transplant program in Guyana, a model for other developing countries, which have a high incidence of blindness due to corneal opacities.

The team developed a private-public partnership, working with government agencies to secure sponsorship, build surgical capacity, identify patients and establish an infrastructure for an eye bank.

Need the best regional/local speaker for your educational program in Europe, Asia, Latin America?

What We Offer

Who are the most qualified speakers on cystic fibrosis in India? Which specialists from Latin America would best fit a regional symposium on advances in rheumatic diseases? If your organization has questions like these in organizing a live or online program, WentzMiller Global Services can help provide the answers.

Our database partner, MedMeme, has an up-to-date listing of more than 1.5 million medical/scientific experts, classified by many criteria, including speaking engagements, research papers, society affiliations, etc.

Once WMGS has identified your organization's needs, we can screen for appropriate candidates, do indepth research on specialists you select (or are recommended to you), and narrow the list to match your needs. Then, if desired, we can do onsite vetting of candidates through our network of Associates and Regional Consultants around the world.

Don't leave the choice of a speaker to chance. A modest investment in WMGS services up front will pay dividends in the future.

Contact us to learn more about WMGS services:

Lew Miller, Principal, 212-933-1027 lew@wentzmiller.org

Greg Paulos, Principal, 623-748-3311 greg@wentzmiller.org

Barbara Pritchard, Principal, 917-881-9685 bpritch887@aol.com

Dennis Wentz MD, Principal, 406-586-9851 dkwentz95@gmail.com

Global CME/CPD Newsletter

Keeping Up Around the World

July-August 2015

Dear CME/CPD Colleagues,

Doctors still love to go to major specialty coferences -- not only to learn from top speakers but also to socialize with colleagues and to get away from the office or hospital for a few days. Nonetheless, the pressures of time, cost and quick access are increasingly driving use of the Internet for learning, as the articles below illustrate. What is yet to be addressed is how Internet education will be funded in the future. Your thoughts?

Does technology drive the CME your organization provides or sup- ports? Does your group prefer tried-and-true live meetings? Or do you look for a balance between the two forms of CME? Trends in several countries indicate that more and more healthcare professionals are opting for online education -- for reasons of cost, time, and convenience.

The 2014 report from the US Accreditation Council for CME (ACCME) shows that many more live courses and regularly scheduled series of CME were developed -- almost 95,000, with almost 900,000 hours of instruction -- compared to 38,000 live and enduring Internet activities, with some 73,000 hours of instruction. But take a good look at this analysis:

In 2005, total physician interactions with live events were 6.5 million vs. only 1.4 million Internet interactions

For every hour of live education prepared in 2014, there were 7.3 physician participants on average, for the most part in hospital-based activities

For every hour of Internet education, there were 60.3 physician participants

Caveats: No data are available on blended learning nor comparative effectiveness per hour of live vs. Internet education

In Europe, a study of senior cardiologists showed an overwhelming preference for high value education at international medical society conferences. Online activities came in third with substantial variation by country: doctors in UK rated these much more highly than colleagues from France and Germany. For the future, 73% of Italian cardiologists want more online CME, but only 10% of Germans.

And social networks limited to physicians are growing. Sermo has expanded to Canada. Doctors.net.uk is offering more accredited online courses. The Skipta network in US serves more than 30 specialized online communities. An Eastern European network, DrPortal.hu, reports 40-70% of doctors in the region are signed on, depending on country.

Will European industry rule changes hurt ACCME providers?

The Accreditation Council for CME also reported that providers received $2.668 billion in total income in 2014, close to the peak of $2.685 billion in 2007. Combined revenue from commercial support, advertising and exhibits dropped from 56% in 2007 to 39% in 2014 (note that data collection differed in the 2 years). Organizational contributions and registration fees made up much of the difference.

These figures do not include pharma company expenditures to pay for travel and lodging to send non-US doctors to US meetings. No total is available. But European pharma and device industries have recently ruled that member companies may no longer directly support such costs. The likelihood is that fewer doctors from overseas will attend the US meetings, thereby reducing provider revenues from registration fees and possibly exhibits

ACCME's view of accredited CME as a "healthy, growing enterprise" may change. The organization is also under attack from Steven Nissen, a leading cardiologist at Cleveland Clinic, who is demanding in a JAMA column that the current system be replaced with an "organization tasked with studying CME effectiveness, providing rigorous oversight of quality and leading educational innovation designed to change medical practice and improve patient outcomes."

In its defense, the 2014 report notes that ACCME providers are required to produce activities to change one or more of these:

Competence (96% are so designed)

Performance (61% are so designed)

Patient outcomes (32% are so designed)

Where are opportunities for CME growth globally?

A scan of recent literature points to four possible areas of growth for CME providers and supporters, three geographic and one specialist:

Mexico, which has not experienced much growth in the health care sector recently, may be poised to do so in the next 5 years as its goal of universal healthcare coverage becomes realized, and doctors and patients have increased access to drug therapy for a range of chronic diseases.

Cuba, which has a strong knowledge economy and an oversupply of well-trained doctors, may become a better market for commercial support of CME as the economy improves as a result of the rapport between the US and Cuban governments.

Africa is seeing very rapid growth in many ways, including pharmaceutical sales, and patients are gaining access to medicines previously unavailable.

Oncology is expected to be the biggest therapeutic class by 2017. The majority of growth will come in the US and the top five European countries, but their share of market will decline as it increases in emerging markets. Targeted therapies account for much of the growth, which may require an equally tailored approach to CME delivery.

The Global Alliance for Medical Education (GAME) is holding its annual meting in Glasgow in conjunction with the Assn. of Medical Education in Europe, which will also have a series of CME sessions. Sept. 5-9. Click for information.

The Alliance for Continuing Education in the Health Professions (ACEhp) has launched a newly updated National Faculty Education Initiative designed to help CME faculty understand the fine line between CME and promotional education. Developed with the Society for Academic CME and the Assn. of American Medical Colleges, it is available online at no cost.

UpToDate, an online clinical decision support resource, has received approval from the Japan Primary Care Assn. (JPCA) as an official CME resource through which members can earn credits.

'Promissory' CME in the Ukraine

The Promissory Concept of distance learning, introduced to GPs and nephrologists in the Ukraine in 2013, combines existing online educational resources with learner needs, aided by an external supervisor.

Participating doctors give constructive feedback on the program, an article in Journal of European CME states, helping create "motivated adherence and improved professional development".

Sunshine Act disclosuresshowed that European companies accounted for 23% of fees paid by industry to US doctors and hospitals in 2014.

Roche paid the most -- more than any US company -for a combination of royalties on cancer drugs and payments for speakers, consultancy, travel and entertainment. GlaxoSmithKline was also a major payer of such fees, despite a pledge from its CEO to phase out such payments.

WMGS offers a new moderate-priced global CME/CPD service

Is your organization seeking to learn more about a country or region to determine whether to take your CME programming there, or join up with a local sponsor? Want to do so without having to gain layers of approval for a major budgeted expense? Our new service can get you started with a minimal investment of under $5,000 (per country) -- and may save you wasted funds or a bad partnership!

In this issue, we are focusing on CME/CPD in emerging markets, leading with a summary of an article written by yours truly with colleagues reporting on credit systems in China, India and Indonesia. These countries, with close to 3 billion population, and almost 3 million physicians, have a major opportunity to improve health care through continuing education.-- Lew Miller

How CME systems function in China, India, Indonesia

Two of the largest countries in the world, China and Indonesia, now have national credit systems for continuing medical education, states an article recently published online in the Journal of European CME. The authors note that in Indonesia, CME/CPD is mandatory for relicensure, and in China is necessary for career advancement as well as re-registration.

Another giant developing nation, India, failed to create a national CME credit system, but 9 of 28 states now have mandated CME for physician re-registration.

How effective are the systems in the 3 countries? The authors note that all are tied to counting credits or credit hours, but point to a lack of adequate needs assessment, outcomes measures, and trained administrators and faculty -- with the possible exception of Indonesia. The latter country has a clearly defined set of goals related to improved health care.

In a related article in the Journal of European CME, the authors summarize proceedings from a recent regional meeting of the Global Alliance for Medical Education (GAME) in Mumbai. The major focus was on India, where "the CME scenario fails to have a systematic and integrated approach to match international standards." In part because of the state-by-state system, "there is an unmet need for the provision of the right CME for the right doctor group at the right time to create appropriate learning levels."

Both articles encourage CME leaders from developed countries to offer assistance whenever possible to the CME leadership in developing nations.

CME goes digital in emerging markets

So reports an article in Forbes, indicating that "weak or nonexistent CME programs prevent health workers from ... keeping their skills sharp" in developing countries in South Asia, Southeast Asia and Africa. "But a big opportunity for rapid progress has emerged as online medical education becomes increasingly common," says the author.

Some platforms help by promoting professional mentoring. In Vietnam, a Harvard Medical School affiliated video conferencing platform connects HIV specialists in top hospitals with frontline health workers in 20 provinces. Other CME platforms are operating on control and prevention of TB in Thailand and China. In the Philippines, a group of doctors founded their own online education community.

Collaboration now exists between the Vietnam Ministry of Health and American partners, including the Accreditation Council on CME, to set up a national CME accreditation system, says a report on a seminar recently held in Hanoi.

Are UK tests of competence fair to older doctors?

The General Medical Council has the right to investigate the fitness to practice of any UK doctor, usually based on evaluating complaints. Some 8000 were recorded in 2013, mainly from the public but sometimes from other doctors or employers. A recent study analyzed concerns that the competency exam given to such doctors was unfair to those who had qualified to practice years ago.

While the study showed that earlier graduates (all GPs) performed less well on the test than their more recently qualified peers under investigation, the researchers stated that "the test format does not disadvantage early qualified doctors". They based their conclusion on studying comparative test results from a group of volunteer GPs who were not under investigation. In this group there was only minor variation based on when each doctor was qualified to practice.

What accounts for the poorer level of performance among those early qualifiers under scrutiny? The authors speculate that "experience alone does not sufficiently maintain clinical knowledge and skills and that a doctor needs to make a conscious effort to remain up to date.... Doctors who engage with high quality continuing development activities have been found to demonstrate better clinical performance than those who do not."

In brief: MD/patient education; Sermo now in Europe; Battle in Europe over off-label prescribing

In response to the article on patient empowerment in our last issue, Dr. Samuel Shortt, quality initiatives director at the Canadian Medical Assn., wrote: "The Choosing Wisely campaign in the US and Canada are great examples of an education intervention targeting both physicians and patients to enable an informed discussion of care necessity."

Sermo, a US online physician community, now has opened its portal to UK doctors, allowing them to explore with US doctors the "grey zone" of medically uncertain cases, among other exchanges. Sermo plans to expand later in the year to Germany, France, Spain and Italy.

Off-label prescribing has long been a topic for discussion in accredited CME programs. Now it's topic for debate in Europe, where some countries are paying for use of a drug off-label because it is cheaper than the product approved for that use. Research pharma companies are objecting. Italy in particular is ignoring EU medicine rules, says a complaint from a group of pharma company associations. Response? The European Commission has authorized a study to be completed this year.

Do MOOCs work when offered in healthcare?

Yes, say the authors of a study on a Massive Open Online Course (MOOC) on dementia developed in Tasmania, and offered to caregivers, people with dementia and healthcare professionals.

"Almost 10,000 people from 65 countries registered, and 38% completed the course," the authors state. The 9-week course included a quiz at the end of each of 3 units, and discussion boards where participant questions could be answered.

"China's population has aged much faster than other populations, and this poses challenges to healthcare", including managing cost, access and quality, says an eyeforpharma report.

"Not only are the Chinese elderly experiencing a rising chronic disease burden, cognition decline and depression are also becoming increasingly prevalent," says the report. And there's a shortage of healthcare workers, many of whom are not well-trained. So there is an excellent opportunity for CME providers.

Need the best regional/local speaker for your educational program in Europe, Asia, Latin America?

What We Offer

Who are the most qualified speakers on cystic fibrosis in India? Which specialists from Latin America would best fit a regional symposium on advances in rheumatic diseases? If your organization has questions like these in organizing a live or online program, WentzMiller Global Services can help provide the answers.

Our database partner, MedMeme, has an up-to-date listing of more than 1.5 million medical/scientific experts, classified by many criteria, including speaking engagements, research papers, society affiliations, etc.

Once WMGS has identified your organization's needs, we can screen for appropriate candidates, do indepth research on specialists you select (or are recommended to you), and narrow the list to match your needs. Then, if desired, we can do onsite vetting of candidates through our network of Associates and Regional Consultants around the world.

Don't leave the choice of a speaker to chance. A modest investment in WMGS services up front will pay dividends in the future.

Contact us to learn more about WMGS services:

Lew Miller, Principal, 212-933-1027 lew@wentzmiller.org

Greg Paulos, Principal, 623-748-3311 greg@wentzmiller.org

Barbara Pritchard, Principal, 917-881-9685 bpritch887@aol.com

Dennis Wentz MD, Principal, 406-586-9851 dkwentz95@gmail.com

Global CME/CPD Newsletter

Keeping Up Around the World

March-April 2015

Dear CME/CPD Colleagues,

In our last issue, we selected 3 areas of focus in 2015 that will affect CME: pressure to improve quality plus control costs, an end of pharma sponsorship for congress attendees, and interprofessional continuing education. We add another new direction: integrating patient education with CME.-- Lew Miller

Does the CME world include patient empowerment?

Patient empowerment and patient-centricity have been terms bandied about for at least a decade -- but 2015 may be the year in which those terms take on meaning to payers, regulators, the pharma industry -- and the public. Surprisingly, little is being said in the CME world about incorporating patient education with education of healthcare professionals. Who better to help empower patients than their doctors? And who better to equip doctors with the tools for patients than continuing medical educators?

Why is patient empowerment taking a front seat now?

Social media are driving the formation of communities of patients to exchange ideas on diagnosis, treatment, alternative therapies, patient support and gripes about the failures of the health care delivery system.

Government agencies, including the FDA in the US and NICE in the UK, want patients involved in their medication decisions.

The pharma industry is funding more patient advocacy groups, and seeking to build social media connections with patients, who are distrustful of industry profit motives.

Pressure from payers and pharma to reduce non-adherence is increasing, as a way to reduce longterm costs and improve the quality of life.

These findings make a clear case for the CME community, including providers and funders, to develop integrated educational programs that (a) bring doctors to a realization of the benefits of patient empowerment; (b) empower patients to ask doctors and other providers what they need to know to improve quality of life, and (c) link together the education of health professionals and that of patients on chronic diseases such as diabetes. Pharma will benefit from funneling its patient education funding into this integrated channel, increasing the likelihood of patient adherence to therapeutic programs.

Write lew@wentzmiller.org with any examples of such integrated programs, so we can share the information with all our readers.

GSK fires 110 in China for misconduct in doctor bribery

The repercussions from the Chinese government's crackdown on GSK in 2013 are continuing. Reports

are emerging that the company has sacked 110 employees for wrongdoing in connection with the accusations that the company was funneling cash to doctors via travel agencies in exchange for prescribing.

GSK's annual report discusses its anti-corruption drive, indicating that nearly 4,000 employees were disciplined for policy violations. In addition, the company's sales in China have been declining.

In a related report, a study from Sweden says that the pharma industry in the UK and Sweden is failing to adhere to its own system of self-regulation. Authors stated that unethical marketing practices were adopted in more than one case per week per country.

New ACCME chief: "Make accreditation process more effective and efficient"

The young Irish doctor, Graham McMahon, who replaces Murray Kopelow as CEO of the Accreditation Council for CME in the US in April, became fascinated with how his teachers approached education when he was a student at the Royal College of Surgeons.

In a MeetingsNet interview, he described his progress into CME, as associate dean for CME at Harvard Medical School and editor for medical education at the New England Journal of Medicine. What does he see for ACCME in the years ahead?

To use educational innovation and technology to enhance teaching, learning and behavior change

To ensure that the accredited CME community can leverage the power of education to promote quality and improve patient care

To simplify and make the process more effective and efficient

In brief: CME on cusp of change; ABIM 'got it wrong'; Value-based assessment of drugs

"The future relationship between the industry and the medical profession will change, and in the process ... CME will be affected," say Robin Stevenson MD, editor of the Journal of European CME, and Eugene Pozniak, director of the European CME Forum, in a recent editorial. They believe that the drug and devices industry in Europe has been an "elephant in the room," influencing medical education in a partisan way. But industry's role is diminishing, and the writers are seeking input on decisions to be made in the CME community. (See Lew Miller's US response as well.)

The American Board of Internal Medicine, after heavy criticism of its Maintenance of Certification program, has said "ABIM clearly got it wrong". The Board is making 5 key changes, including a 2-year suspension of the requirement for practice performance projects.

The British pharma industry wants the UK government to revive efforts to assess new medicines on a value-based approach -- ideally taking a broader societal view of their value, which industry believes could mean fewer rejections of novel therapies.

Can CME reduce diagnostic errors?

That's the question implicit in a recent BMJ analysis of diagnostic errors as a major contributor to harmful patient outcomes.

The authors state that most healthcare organizations have not integrated tools to measure such errors nor to reduce their occurrence.

Is your organization seeking to learn more about a country or region to determine whether to take your CME programming there, or join up with a local sponsor? Our expanded list of 10 Associates and 8 Regional/Country Consultants gives new meaning to WentzMiller Global Services. Here are the 8 consultants who have joined our ranks:

We just returned from an exciting meeting of the Alliance for Continuing Education in the Health Professions (ACEhp), just celebrating its 40th anniversary with over 1,200 in attendance. We were particularly struck by a keynote address from Laura Adams, President of Rhode Island Quality Institute. As a former nurse who had been diagnosed with breast cancer, she reminded us of the many issues in healthcare delivery that as educators we need to address, including doctor-nurse-patient communications, . Disease diagnosis and management is only part of our responsibility! -- Lew Miller

Stay relevant: New directions for CE in 2015

The pace of change affecting the role of continuing medical educators around the globe will quicken in 2015. Here are some trends to watch -- and act upon to stay relevant:

Increasing pressure from government health authorities to demonstrate improvement in patient care coupled with cost control

Reduced and redirected financial support from the pharmaceutical/devices industries; in Europe and perhaps elsewhere, companies will discontinue sponsoring doctor attendance at major congresses; more global CME grants will be awarded (see next article for details)

More interest in interprofessional education to build teamwork in delivery of care

At its 40th annual meeting last week, the Alliance for Continuing education in the Health Professions (ACEhp) unveiled a roadmap for Quality Improvement Education (QIE) that called on continuing healthcare educators to work closely with quality leaders in hospitals and other delivery settings to bring CE programs in line with data indicating gaps in quality and costs of care. Educators often complained that quality staff were unwilling to share such data -- which should be the basis for education needs assessment. And needs assessment has to reach beyond disease areas to staff-patient communications and management of systems change.

In the US, Canada, Pakistan and a few other countries, medical schools and hospitals are major providers of CE, and have the best opportunity to access patient data from their delivery systems.But educators need to get top leaders of their institutions to recognize the need for their role in collaboration to improve quality and control costs.

It is the medical specialty societies (and in some cases, medical education companies) that are at greater risk of becoming irrelevant -- and falling short of revenue needs. These societies have been the bulwark of CE in most countries, have designed their own approach to programming, and have derived substantial revenue from industry support of delegates. What are some directions for societies to consider in 2015 to remain relevant?

Work with regional and national government sources to collect and use specialty-based patient data as a basis for identifying gaps in care -- whether knowledge or system gaps -- and for measuring CME outcomes

Restructure programs from large lectures to small interactive groups, with content based on gap data, with repetitive support, and with measured outcomes

Work closely with industry to re-direct delegate support funds into CE grants to support new approaches to educational programs

A recent report on the effectiveness of CME emphasized recommendations 1 and 2, noting that the systematic reviews analyzed "conclude that CME has a more reliably positive impact on physician performance than on patient health outcomes." Those reviews also concluded that CME leads to improvement "if it is more interactive, uses more methods, involves multiple exposures, is longer and is focused on outcomes that are considered important by physicians."

How industry support will change in 2015

The role of the pharmaceutical/device industries in support of CME/CPD will change dramatically this year:

Transparency disclosures about payments to physicians start appearing in Europe, Japan and Australia this year. These are already shaking up some companies and doctors in the US, because of the size of payments. Remember, in US, CME payments are exempt from reporting -- which is not the case in other regions. Watch for fallout!

EUCOMED, the European medical device industry organization, has announced it will discourage members from paying support to send doctors to congresses. EFPIA, its pharma industry counterpart, is considering such a step. Though voluntary, these industry pronouncements are widely heeded. As noted above, try to channel those funds into direct CME support.

CME grants on a global or regional scale will increasingly come from headquarters offices of medical education or scientific affairs rather than channeling through local managers' budgets, and require stricter adherence to processes of needs assessment and outcomes measurement.

Consider the possibility of gaining US accreditation from the Accreditation Council of CME (not an easy task) to maintain or gain credibility with physicians, national authorities and industry. Keep in mind that accreditation will not permit an organization to grant AMA PRA credits -- even to physicians with US licenses (contrary to our report in the last issue). Only the AMA can do that.

"How France messed up CPD/CME"

That's the leadoff title of an editorial in BMJ by Dr. Herve Maisonneuve, a WMGS associate. He continued:

"For the past 20 years, French decision makers have tried to implement a CPD/CMS system for healthcare professionals. The current system, which was implemented in 2012, is about to collapse."

Dr. Maisonnueve blames this on a topdown system based on "28 sophisticated CPD methods", a major departure from CME gained in conferences, journals, etc. But physicians weren't ready to change. A government audit now recommends 4 alternatives, only one of which would keep and simplify the existing system. The rest would return control of CME to the profession. The author predicts "no decision ... which means that France will never implement a fair system of CPD."

In brief: New head for ACCME; European journal new policy; CHCP now, not CCMEP!

Graham McMahon MD succeeds Murray Kopelow MD as CEO of the US Accreditation Council for CME (ACCME) in April. Dr. Kopelow served ACCME for 30 years. Dr. McMahon is a native of Dublin, Ireland; he is a practicing endocrinologist and has most recently been associate dean for CME and associate professor at Harvard Medical School. "I envision creating new opportunities for accredited CME to demonstrate that it is ... the currency for quality improvement," he says.The Journal of European CME has announced a change in policy -- free publication of articles that have been accepted after peer review. Robin Stevenson MD, editor, announced the change, thanks to generous support from European CME Forum and European Board for Accreditation in Cardiology. "This should encourage more submissions on advances in European CME-CPD," he commented.

CME professionals in the US who proudly carried the initials CCMEP after their names now have a new designation: CHCP. The National Commission for Certification of CME Professionals has changed its name to Commission for Certification of Healthcare CPD Professionals, and its credential from Certified CME Professional to Certified Healthcare CPD Professional. Its exam is being expanded accordingly, and will also include more quality issues. But certificate holders are grandfathered under the new designation.

Vietnam developing an accreditation system

The Vietnam Ministry of Health invited Murray Kopelow MD, retiring CEO of the US Accreditation Council, to consult on development of a system there.

Other partners in the discussion included a Harvard Medical School collaboration in Vietnam.

The National CME Commission of China has launched its 2015 program to strengthen a shortage of medical personnel training and to support CME in general medicine, mental health and pediatrics.

A shortlist of specific projects will be released in March.

WMGS offers a new moderate-priced global CME/CPD service

Is your organization seeking to learn more about a country or region to determine whether to take your CME programming there, or join up with a local sponsor? Want to do so without having to gain layers of approval for a major budgeted expense? Our new service can get you started with a minimal investment of under $5,000 (per country) -- and may save you wasted funds or a bad partnership!